Physicians for Reproductive Choice and Health (PRCH) is a physician-led national advocacy organization that relies upon evidence-based medicine to promote sound reproductive health policies. PRCH opposes H.R. 3803, the “District of Columbia Pain-Capable Unborn Child Protection Act.” This bill would ban abortion in the District of Columbia at 20 weeks after fertilization. This measure is clearly unconstitutional and would harm women’s health.1 Moreover, the bill is incredibly disrespectful of women, doctors, and the residents of the District of Columbia.
I am a board-certified obstetrician/gynecologist living and practicing medicine in the District. I have worked with Planned Parenthood of Metropolitan Washington, taught at the University of Hawaii John A. Burns School of Medicine, and served as an Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention. I received my medical degree from the University of Iowa, my master’s degree in public health from the Harvard School of Public Health, and my master’s degree in science in health services research from the University of Michigan, where I also completed a fellowship in family planning. I have more than 20 years of experience in women’s health and have served on the PRCH board since 2007. I am pleased to submit this testimony in opposition to H.R. 3803 on behalf of PRCH.
I. H.R. 3803 Would Deny Women Needed Medical Care
Most abortions in the United States are provided early in pregnancy; roughly 12% of abortions occur at or after 13 weeks after a woman’s last menstrual period (LMP). Only 1.4% of abortions occur at or after 21 weeks LMP. But some women will need abortion care later in pregnancy. H.R. 3803 would deny these women badly needed safe medical care.
While most women can look forward to a safe pregnancy, pregnancies can go terribly wrong. I remember caring for a senior staff member of a U.S. senator. At 23 1/2 weeks LMP, she discovered that her very desired pregnancy was complicated by a deadly fetal anomaly. She and her husband were distraught—this was their first child—but resolute that abortion was the right decision for them.2
The difficult circumstances described above are not uncommon for abortions after 20 weeks post-fertilization, where discovery of complications and decision-making often occur. A physician in the PRCH network, Dr. Grace Shih in San Francisco, remembers one of her patients, whose water broke at 22 weeks LMP. Her pregnancy was doomed. Her wish was to have an abortion, as safely and quickly as possible, so that she could return home to her family and move forward.
Dr. Cat Cansino of Columbus, Ohio, cared for a patient whose pregnancy was diagnosed with a lethal fetal anomaly incompatible with life, after several consultations with high-risk obstetricians and neonatologists. Her patient shared with her how difficult it was to decide on abortion and also how hard it would have been to continue a pregnancy wondering when her baby would die while inside her.
Another physician, Dr. Aileen Gariepy of New Haven, Connecticut, took care of Angela, a 25-year-old woman with a very wanted pregnancy. She had come to Dr. Gariepy for a routine ultrasound at 23 weeks LMP. The ultrasound showed abnormalities, and later, the fetus was diagnosed with a lethal form of fetal skeletal dysplasia, a fatal bone disorder. Continuing the pregnancy would mean waiting for the fetus to die in utero, during labor, or immediately after delivery. Angela and her partner felt that the most compassionate thing to do was to end what they perceived as their baby’s suffering and their own.
H.R. 3803 takes away decision-making from DC women and their doctors and replaces it with political judgment. Politicians should not insert their ideology into the most personal decisions of a woman and her family.
II. H.R. 3803 Lacks Adequate Exceptions, Contains Onerous Reporting Requirements, and Criminalizes Doctors’ Care
H.R. 3803 only has a narrow exception for the life of a woman, inadequate exceptions to protect women’s health, and no exceptions for rape, incest, or fetal anomalies. Many serious health conditions materialize or worsen later in pregnancy, such as placental bleeding. PRCH’s consulting medical director, Dr. Anne Davis of New York, cared for a mother of two who was 22 weeks pregnant LMP. She had been bleeding throughout her pregnancy, but since this was a very desired pregnancy, she was waiting and hoping for the best. Her condition developed into placental abruption, which is where the placenta separates from the uterine wall, causing bleeding and depriving the fetus of oxygen. Her bleeding increased, and she was reaching the point where she would have suffered massive hemorrhage, shock, and death. Her pregnancy had to end. She survived and hopes to have more children.
I remember caring for a woman pregnant with her first child that developed a clotting disorder. The clotting disorder had destroyed her liver; she needed a liver transplant to save her life. She had to have an abortion so that she could have a liver transplant. H.R. 3803 would jeopardize the lives and health of all of these women. As discussed above, lethal fetal anomalies are also often not diagnosed until 20 weeks or later. H.R. 3803 would force women in the District to travel out of state (if they had the resources) or would deny them safe care altogether.
H.R. 3803 also contains an onerous and invasive reporting requirement. Any physician providing abortion care in the District would have to file reports on their patients. H.R. 3803 requires reporting of the gestational age of the pregnancy, the abortion method, and the age of the woman. The information would then be complied into a public report. While the legislation states that no information shall be included that could lead to the identification of patients, the language is inadequate and the legislation is silent as to the identification of doctors. When the CDC and many other states collect data, they require that statistics be provided in the aggregate. Aggregating statistics is necessary to protect the confidentiality of patients and physicians, and while the bill mentions confidentiality, it does not adequately ensure it.3 The District of Columbia is a small jurisdiction, which means that without sufficient protections, physicians could be singled out and identified, putting them at risk of violence and harassment. This is unacceptable.
This cruel legislation abandons and endangers women by criminalizing safe abortion. H.R. 3803 places my colleagues and me in the position of telling women that we cannot provide the medical care they need and deserve or risking civil and criminal penalties. Violation of this bill would result in fines and/or imprisonment of up to two years. The bill also grants the ability to sue for violations to relatives of the woman. These provisions are clearly intended to intimidate health care providers from providing abortion care.
Some states have already passed laws to ban abortions 20 weeks after fertilization. H.R. 3803 would create such a requirement in the District of Columbia. The DC government has not introduced this law—instead it has been introduced by Representative Trent Franks (R) of Arizona. Representative Franks and his cosponsors (none of whom represent the District of Columbia) purport to know what is best for the District, attempting to legislate an abortion restriction that the democratically elected local government has not supported or enacted.
There is a dearth of abortion providers in the United States. Eighty-seven percent of U.S. women live in a county where there is no access to abortion. There is even less access for women who need abortion care after 20 weeks. My friend and colleague Dr. George Tiller of Kansas provided this needed care in Wichita until he was murdered in his Kansas church nearly three years ago. Dr. Tiller understood the needs of women in such complicated medical situations, making it his life’s work to provide them with safe medical care.
The imposition of this ban in the District is meant not only to deprive DC women of safe and legal medical care, but also to intimidate and harass my colleagues and me who provide comprehensive and compassionate care to our patients. On behalf of PRCH, I urge you to vote against H.R. 3803.
2. Compounding the horror of their situation were the delay and struggle they experienced when her federally funded health insurance initially refused to cover her abortion. I performed her procedure without complication, for which they were very grateful.
3. For example, the State of Alabama’s statute specifies that the data be made available in the aggregate. (Alabama Statutes Section 22-9A-13.) The State of Michigan has a similar requirement: “the department shall make available annually in aggregate a statistical report summarizing the information submitted in each individual report required by this section [emphasis added].” (Michigan Public Health Code 333.2835).